Rheum/musculoskeletal Flashcards
(305 cards)
1
Q
Deposition of Monosodium urate crystals in joints
A
gout
2
Q
Hyperuricemia
A
uric acid greater than 6.8. Treatment only indicated in those undergoing cytotoxic treatment.
3
Q
Primary Overproducers
A
idiopathic, genetic
4
Q
Secondary Over producers
A
increased purine consumption, malignancy, psoriasis, enzyme defects.
5
Q
Primary underexcreters
A
idiopathic
6
Q
secondary underexcreters
A
Most common. decreased renal function, metabolic acidosis, dehydration, meds, lead nephropathy.
7
Q
Stage 1 gout
A
elevated uric acid levels with no symptoms.
8
Q
Stage 2 gout
A
acute attack of arthritis
9
Q
stage 3 gout
A
10 or more acute attacks. chronic swelling and tophi
10
Q
Podagra
A
gout affecting the first MTP
11
Q
Tophi
A
large aggregated crystals in the joint
12
Q
Gout presentation
A
rapid onset, severe pain, redness, warmth and swelling. Usually monoarticular (big toe).
13
Q
Gout triggers
A
ETOH, trauma, any medications that change uric acid levels, high purine consumption.
14
Q
Xray of gout
A
Joint erosion. “rat bite”
15
Q
Arthrocentesis of gout
A
gold standard. needle shaped and NEGATIVE birefringent crystals
16
Q
24 urine uric acid
A
overproducers with have more than 800mg on a normal diet.
17
Q
Acute Gout Attack Treatment
A
1st line: NSAIDS, indomethacin 50mg TID or naproxen 500mg BID
2nd line: colchicine 1.2mg followed by 0.6mg an hour later then 0.6mg BID.
3rd line: Glucocorticoids
18
Q
Gout prevention
A
avoid high purine foods, prophylactic treatment and urate lowering therapy.
19
Q
Chronic gout treatment indications
A
frequent attacks, polyarticular, tophi, renal stones.
20
Q
Gout treatment goals
A
SUA of 6.0mg or less.
21
Q
Probenecid
A
Gout. For underexcreters. Enhances renal excretion. 250mg BID. Avoid with nephrolithiasis and aspirin.
22
Q
Allopurinol (Xanthine oxidase inhibitor)
A
Agent of choice for gout. Decreases uric acid synthesis. 300mg a day. renal dosing.
23
Q
Febuxostat (xanthine oxidase inhibitor)
A
similar to allopurinol. safe with mild-moderate renal insufficiency.
24
Q
Chronic gout treatment
A
urate lowering therapy should be started 2 weeks after an acute attack. need to have prohpylaxis of NSAIDS/colchicine before starting.
25
Calcium pyrophosphate dihydrate depostion disease
Pseudogout
26
chondrocalcinosis
radiographic evidence of calcification. punctate and linear.
27
psuedogout presentation
acute, monoarticular inflammatory arthritis. usually effects the knees, wrists or shoulder.
28
Pseudogout arthrocentesis
POSITIVELY birefringent. rhomboid shaped CPPD crystals.
29
Psuedogout acute treatment
NSAIDS, colchicine, glucocorticoids. Joint aspiration. intrarticular glucocorticoids. immobilization and ice.
30
Pseudogout prophylaxis
if greater than 3 attacks per year. Cochicine 0.6mg BID
31
Systemic Lupus Erythematosus (SLE) Etiology
Autoimmune disorder with autoantibodies to nuclear antigens. Genes, environment, hormones.
32
SLE pathogenesis
ANA then antibody/antigen complexes then deposit in tissues which activate complement causing inflammation.
33
SLE presentation
Fever, Fatigue, weight change, photosensitivity, alopecia, malar/discoid rash, arthritis, serositis, lupus nephritis, seizures, Raynaods phenomenon, peritonitis, vasculitis, ophthalmologic involvement, recurrent fetal loss.
34
SLE Diagnosis
ANA is cardinal feature but is not specific. immunofluorecence shows anti-dsDNA and anti-sm antibodies.
35
SLE treatment
Step wise approach. NSAIDS. Antimalarials (hydroxychloroquine with ophthalmologic follow up). systemic corticosteroids. cytotoxic/immunosuppressive agents (methotrexate, azathioprine). Belimumab (monoclonal antibody).
36
Drug induced SLE
Constitutional symptoms, pleuropericardial symptoms. Positive antihistone antibody.
37
Drug induced SLE treatment
stop the offending drug
38
Sjogren Syndrome etiology
Chronic, autoimmune. Diminished exocrine gland function.
39
Sicca complex
dry eyes and mouth
40
sjogren syndrome presentation
fatigue, keratoconjunctivitis (dry eyes), xerostoma, parotid gland enlargement, mucous membrane dryness, arthritis, Raynaud's, lymphadenopathy, pulomary disease, vasculitis, nephritis, lymphoma.
41
Raynaud's phenomenon
episodic vasospastic disease. white then blue then red fingers.
42
Sjogren syndrome diagnosis
ANA. Anti-Ro/ssa and anti-La/ssB. elevated RF.
43
Sjogren syndrome treatment
Dentist and optomotrist follow up. cyclosporine eye drops (restasis), biotene. Steroids/immunosuppressants.
44
Systemic sclerosis (scleroderma) etiology
Rare, chronic autoimmune disorder causing diffuse fibrosis of skin and organs.
45
Systemic sclerosis pathogenesis
immunologic mechanisms lead to vascular endothelial damage and activation of fibroblasts.
46
Systemic sclerosis presentation
arthritis, pulmonary fibrosis, pericarditis, renal failure, cutaneous symptoms.
47
Limited cutaneous systemic sclerosis
CREST. Calcinosis cutis, Raynaud's, Esophageal dysmotility, Sclerodactyly (puffy hands), Telengiectasia.
48
Diffuse cutaneous Systemic sclerosis
rapid symmetric skin thickening of trunk and proximal extremities.
49
Systemic Sclerosis Diagnosis
ANA. anti-SCL-70 and anti-centromere antibodies.
50
Systemic Sclerosis Treatment
Supportive. Raynauds: nifedipine. Esophageal dysmotility: H2 blockers. HTN: ace inhibitors.
51
Reactive Arthritis etiology
inflammatory arthritis triggered by a GI/GU infection (diarrhea or urethritis). shigella, salmonella, yersinis and campylobacter. chlamydia.
52
Reactive Arthritis Presentation
asymmetric oligoarthritis (can't climb a tree), conjunctivits (can't see), urethritis (can't pee). ulcers, keratoderma blennorrhagicum (hyperpigmentation of soles/palms), circinate balanitis (on penis), nail changes.
53
Reactive Arthritis Diagnosis
HLA-B27 antigen. Synovial fluid: inflammation but non infection.
54
Reactive arthritis treatment
NSAIDS: indomethacine 25-50mg TID.
55
Rhuematoid Arthritis (RA) etiology
autoimmune, chronic, inflammatory disorder.
56
RA pathogenesis
Interluekins effect the T cells, increasing TNF, leading to inflammation and osteoclastogenesis causing bone erosion.
57
RA Presentation
symmetric polyarthritis. Morning sitffness >1 hour. Pain, swelling, MCP and DIP joints. Ulnar deviation. Boutonniere, swan-neck, interosseous hypertrophy. Adhesive capsulitis, baker's cyst, metatarsal head subluxation.
58
RA Extraarticular manifestations
constitutional symptoms, rheumatoid nodules, episceleritis/scleritis, pericarditis, plueritis, sicca, hematologic. Cardiovascular disease is most common cause of death.
59
Felty Syndrome
RA, Splenomegaly, neutropenia.
60
RA radiology
soft-tissue swelling, osteopenia, narrowing of the joint, subluxation, bone erosion/joint obliteration.
61
RA Labs
Rheumatoid Factor. Anti-CCP, ANA (30%). Inflammatory markers (ESR and CRP).
62
RA Treatment
Exercise with rest periods. NSAIDS, glucocorticoids, Disease Modifying Antirhuematic Drugs (DMARD)
63
Synthetic DMARDs
Methotrexate, sulfasalazine, hydroxycholoraquine.
64
Biological DMARDs
Inhibit inflammatory cytokines (TNF-alpha). High risk of infection, myelosuppression and malignancy. Etanercept (enbrel), Infliximab (remicaid), Adalmumab (humira).
65
Osteoarthritis (OA) Pathogenesis
damage leads to chondrocytes then degradative enzyems causing thinning of articular cartilage and bone remodeling (bone spurs and joint space narrowing).
66
OA Symptoms
pain that is exacerbated by activity and relieved by rest. Morning stiffness that last for less than 30 minutes.
67
OA General Signs
crepitus, bony enlargements, decreased ROM, malalignment, tenderness.
68
OA of the hands
Heberden's nodes ( DIP), bouchard's nodes (PIP), oftern in first CMC joint.
69
OA of the knees
Osteophytes, effusions, crepitus, decreased ROM.
70
OA of the hip
decreased internal rotation, pain in hip/groin, pain that radiates to the knee.
71
OA radiology
joint narrowing, osteophytes, subchondral sclerosis, subchondral cysts.
72
OA Treatment
Weight loss, PT, tylenol, NSAIDS, narcotics (sparingly), topical NSIADS (diclofenac or capsaicin), intraarticular glucocorticoids or hyaluronic acid.
73
Polymyalgia Rheumatica Etiology
Chronic, inflammatory rhuematic condition associated with giant cell temporal arteritis. women > 50 years old.
74
Polymyalgia presentation
morning stiffness, symmetric, shoulder>hip/neck pain, synovitis/bursitis, edema, decreased ROM, subjective weakness, systemic symptoms.
75
Polymyalgia Labs
elevated ESR > 40.
76
Polymyalgia diagnosis
Proximal bilateral aching with morning stiffness for > 30 mins for > 2 weeks. Rapid resolution with low-dose glucocorticoids.
77
Polymyalgia Treatment
NSAIDS, PT, glucocorticoids (15-20mg/day).
78
Fibromyalgia etiology
idiopathic. Soft tissue pain disorder with widespread, chronic pain. No inflammaiton.
79
Fibromyalgia presentation
aching, stiffness, paresthesias, HA, fatigue, mood disturbances (anxiety and depression), disturbed sleep, pelvic pain, IBS, painful bladder syndrome.
80
Fibromyalgia diagnosis
All labs are negative. Symptoms of widespread pain that is above/below the waist and on right/left sides of the body with at least 11/18 tender spots.
81
Fibromyalgia Treatment
NSAIDS, Cyclobenzapine (muscle relaxer), antidepresants (amitriptyline, duloxetine, milnacipran), anticonvulsants (pregabalin, gabapentin). Avoid narcotics.
82
Rotator Cuff Muscles in order
Supraspinatus, infraspinatus, teres minor (external rotation and abduction), subscapularis (internal rotation).
83
Most common rotator cuff tear
supraspinatus
84
General Rotator Cuff symptoms
Pain over anterior/lateral shoulder. Radiates to deltoid. Occurs with overhead activities. Decreased abduction.
85
Rotator Cuff tests
drop arm (complete tear), empty can, neer's, hawkins.
86
Tendinosis
Degeneration of muscles typically due to age
87
Tendonitis
Inflammation due to repetitive trauma
88
Chronic rotator cuff tear causes
Degeneration, impingement and overload. Overhead occupations. Anatomical variations that cause narrowing. Men >40.
89
Acute rotator cuff tear causes
Traums. acute pain with negative radiographs. Labral pathology.
90
Chronic rotator cuff symptoms
Pain worse at night. gradual weakness. Does NOT improve with analgesics. positive drop arm and empty can tests.
91
Rotator cuff radiography
elevation of humeral head suggests tear.
92
MRI of rotator cuff
if full thickness is suspected of labral pathology.
93
Acute Rotator cuff tear treatment
Ice, NSAIDs, weighted pendulum stretch BID, restrict overhead movement, immobilization for a short time, PT after initial rest.
94
Chronic Rotator Cuff tear treatment
subacromial steroid injection (3-4 times per year). Surgery either arthroscopic or joint arthroplasty.
95
Shoulder impingement Syndrome Presentation
subacromial tenderness, normal ROM but pain at >90 degrees. Deep ache. Preserved strength. Pain with flexion and internal rotation. Positive neer's and hawkins tests. Improves with analgesics.
96
Shoulder impingement syndrome treatment
Ice, NSAIDs, activity modification, PT. Steroid injections if persistent. Surgery if anatomical variation can be fixed.
97
Adhesive capsulitis etiology
trauma, overuse, bursitis, sling use.
98
Adhesive capsulitis Presentation
chronic pain, decreased ROM due to mechanical restirction. usually effects abduction and external rotation. positive apley's scratch test.
99
Adhesive capsulitis treatment
PT
100
Acromioclavicular Injury MOI
fall onto the tip of the shoulder with the arm tucked into the side.
101
Acromioclavicular Injury Presentation
AC joint swelling/deformity/tenderness. Pain worse at bedtime. Pain worse with downward traction and cross-over test.
102
AC injury grade I
Sprain. Radiographs are normal.
103
AC injury Grade II
speration of the superior/inferior AC ligaments. Instability, decreased ROM. Radiograph shows inferior margin of clavicle lies above the inferior margin of the acromion.
104
AC injury Grade III
Seperation of superior/inferior AC and coracoclavicular ligament. Clinical deformity. Severe pain. Radiograph shoes the inferior margin of the clavicle above the superior margin or the acromion.
105
AC injury treatment
Ice, rest, NSAIDs, shoulder immobilizer (3-4 weeks), corticosteroid injection .
106
AC injury surgery
Grade III with fixation, ligament reconstruction and distal clavicle resection.
107
Typical Clavicle fracture
occurs in the middle and displaces superiorly.
108
Clavicle fracture presentation
visual deformity, tenderness, decreased ROM with apprehension.
109
Clavicle fracture treatment
sling/swathe or figure 8 harness. analgesics, muscle relaxers.
110
Clavicle fracture ortho referral if...
displaced mid clavicle and all proximal/distal fractures.
111
Subacromial bursitis etiology
inflammation or degeneration of the bursa due to repetitive movement or a systemic disease. Can be associated with rotator cuff tendonitis/impingement.
112
Subacromial bursitis presentation
pain with ROM and at rest. localized tenderness of subacromial area.
113
Subacromial bursitis treatment
ice, NSAIDs, rest, aspiration and corticosteriod injections
114
Carpal Tunnel syndrome (CTS) pathogenesis
Repetitive activities that cause swelling of the synovium and thickening of the transverse carpal ligament.
115
CTS presentation
Chronic intermittent pain (dull ache) leading to burning pain, numbness, tingling and weakness. worse at night.
116
CTS Tests
Phalens and tinels
117
CTS signs
Thenar atrophy, decreased sensory and and strength in median nerve distribution.
118
CTS Diagnostics
Grip strength test, nerve conduction tests, electromyogram.
119
CTS Treatement
NSAIDs, steroid injuections, brace, PT, surger.
120
Acute CTS treatment
Immediate decompression.
121
Ganglion cysts Etiology
collection of synovial fluid within a joint or tendon sheath.
122
Ganglion cyst presentation
dorsal/volar aspect of wrist. Soft mobile mass that fluctuates in size.
123
Ganglion cyst treatment
NSAIDs, aspiration with steroid injection. Often resolve on their own.
124
De Quervain's tendosynovitis etiology
Inflammation of the first dorsal compartment involving abductor pollicis longus and extensor pollicis brevi due to overuse (repetitive gripping).
125
De Q's Presentation
pain/swelling along dorsal wrist. positive finkelstein's test. Pain aggravated by gripping.
126
De Q's Treatment
rest, thumb spica immobilization, NSAIDs, steroid injections.
127
Boutonniere deformity
PIP flexion, DIP hyperextension.
128
Swan neck deformity
PIP Hyperextension, DIP flexion.
129
Biceps tendonitis etiology
Inflammation of the long head of the bicep as it passes through the bicepetal groove. Due to repetitive lifting.
130
Biceps tendonitis presentation
pain in anterior shoulder (bicipetal groove), pain with abduction and external rotation, popping, weakness.
131
Biceps tendonitis tests
Yergason's and speeds.
132
Biceps tendonitis treatment
NSAIDs, rest, PT to strengthen the bicep.
133
Glenohumeral dislocation/subluxation Presentation
Sulcus sign, usually dislocates anteriorly, apprehension/relocation test.
134
Multi-axial instability treatment
PT, analgesics, ice and rest.
135
Glenohumeral dislocation treatment
immediate reducation, should immobilizer (2-4 weeks), analgesics, PT. Consider axillary nerve damage (numbness over deltoid).
136
Bankart lesion
detachment of anterior/inferior labrum from glenoid rim
137
Hills-Sachs lesion
cortical depression of posterolateral humeral head.
138
Elbow epicondylitis etiology
over use.
139
Elbow epicondylitis presentation
localized pain/swelling. Reproducible pain with wrist flexion (medial) or wrist extension (lateral).
140
Medial elbow epicondylitis
golfer's elbow. Wrist flexors and protonators.
141
Lateral elbow epicondylitis
tennis elbow. wrist extensors and supinators.
142
Elbow epicondylitis acute treatment
sling, wrist brace, ice, NSAIDs.
143
Elbow epicondylitis prevention
forearm strap, correct technique, minimize repetitive injury.
144
Elbow epicondylitis chronic treatment
steroid injections and surgery.
145
Olecranon bursitis etiology
trauma, prolonged pressure, infection, rhematological conditions.
146
Olecranon bursitis presentation
swelling, +/- pain, +/- decreased ROM
147
Olecranon bursitis treatment
Ice, NSAIDs, aspiration.
148
Olecranon bursitis Prevention
elbow pads, change activity.
149
Cubital tunnel Etiology
Compression of the ulnar nerve due to repetitive motion, pressure, fluid or trauma.
150
Cubital tunnel presentation
ulnar nerve neuropathy, decreased grip strength, muscle wasting.
151
Cubital tunnel treatment
NSAIDS, bracing, PT, surgery (cubital tunnel release or ulnar nerve transposition).
152
Dupuytren's contracture etiology
connective tissue disorder. progressive fibrosis of the palmar fascia.
153
Dup's contracture presentation
painless nodules that become palpable cords along the palmer surface. Loss of finger extension.
154
Dup's contracture Test
hueston table top test
155
Dup's contracture treatment
stretching, splinting, massage, glucocorticoid injections, surger if contracture is >30 degrees.
156
Trigger thumb/finger etiology
nodule on volar aspect of the MCP
157
Trigger thumb/finger presentation
digit snaps/catches at IP or PIP joint. Becomes painful.
158
Trigger thumb/finger treatment
NSAIDs, steroid injections, surgery to release the A1 pulley.
159
Strain
muscle/tendon injury
160
Sprain
ligamentous injury
161
Radiculopathy
Lower motor neuron dysfunction. Dermatomal distribution. hypoactive reflexes. Flaccidity. Fasciculations.
162
Myelopathy
Upper motor neuron dysfunction. Hyperactive reflexes. clonus. upgoing toes (babinski). spasticity.
163
C5 Sensory
Lateral/upper arm and shoulder.
164
C5 Motor
deltoid and some bicep (abduction)
165
C5 DTR
Biceps or brachioradialis
166
C6 sensory
dorsolateral arm, forearm and thumb
167
C6 motor
biceps, brachioradialis and wrist extensors.
168
C6 DTR
biceps or brachioradialis
169
C7 sensory
mid-dorsal forearm and middle finger.
170
C7 Motor
triceps, wrist flexors and finger extensors.
171
C7 DTR
Triceps
172
C8 sensory
medial forearm, ring finger, small finger.
173
C8 motor
thenar eminence and interossei.
174
L3 sensory
anterior thigh
175
L3 motor
iliopsoas.
176
L3 DTR
knee jerk
177
L4 sensory
anteromedial thigh and medial leg.
178
L4 motor
quads
179
L4 DTR
knee jerk
180
L5 sensory
lateral thigh and anterior calf.
181
L5 motor
foot dorsiflexion, anterior tibialis and extensor hallucis longus.
182
S1 sensory
Posterior calf and heel.
183
S1 motor
gastrocnemius.
184
S1 DTR
achilles
185
X-ray films indications
trauma, degenerative diseases.
186
CT indications
bony detail
187
MRI indications
soft tissue structures and neural compression
188
Bone scan indications
infectious or metastatic diseases
189
Electromyogram (EMG)
differentiates root vs. peripheral vs. plexus problem
190
Nerve conduction study
problem with the axon vs. myelin. determines the amplitude and speed of response.
191
Cervical sprain etiology
rapid deceleration injury that causes hyperextension then flexion. inflammatory response that presents 2-24 hours after trauma.
192
Cervical Sprain Presentation
gradual onset of stiffness/soreness. HA at base of skull. shoulder pain.
193
Lumbar Sprain etiology
lifting and twisting
194
Lumbar sprain presentation
worsens with activity and resolves with rest. radiates to the buttocks. common to have reoccuring episodes.
195
Signs of spinal strains/sprains
tenderness, decreased ROM due to pain, muscle spasms.
196
Spinal strain/sprain imaging
plain films
197
Spinal strain/sprain treatment
Rest (no more than 48 hours), RICE, NSAIDS (for 72 hours not PRN), PT, usually resolves withing 4 weeks.
198
Herniated lumbar disk etiology
Repetitive movements or acute injury usually L4/5 or L5/S1 posterolateral. Often associated with lumbar strain.
199
Herniated Lumbar disk Presentation
Pain radiating down the back of the legs. Aggravated by coughing/sneezing. Hard to get comfortable. Trunk shifted to one side for compensation.
200
Herniated Lumbar disk Diagnostics
Straight leg raise test (gold standard). MRI.
201
Herniated Lumbar disk treatment
Best rest (1-2 days), NSAIDs, muscle relaxants (cyclobenzaprine), heat or ice, PT. Urgent referral for any neuro deficits. Surgery if intractable or neuro deficits.
202
Cervical Spondylosis etiology
degenerative disk disease and hypertropy of ligamentum flavum and facets.
203
Cervical Spondylosis Presentation
unilateral radicular symptoms or bilateral myelopathy. tenderness, muscle spasms.
204
Cervical spondylosis treatment
Best rest (1-2 days), NSAIDs, muscle relaxants (cyclobenzaprine), heat or ice, PT. Urgent referral for any neuro deficits. Surgery if intractable or neuro deficits.
205
Cauda Equina Syndrome etiology
Massive midline herniation. Neuro Emergency.
206
Cauda Equina Presentation
acute onset of low back pain, sciatica, urinary retention, decreased anal sphincter tone, "saddle" anesthesia.
207
Cauda Equina Imaging
MRI
208
Cauda equina treatment
urgent surgical decompression or oncology referral for metastatic disease.
209
Spondylolysis
Defect in the pars interarticularis (collar on the scottie dog) due to repetitive hyperextension of the back. common in adolescents. treated with NSAIDs and rest.
210
Spondylolisthesis etiology
degenerative disk disease causing anterior displacement of one vertebra on another.
211
Spondylolisthesis Presentation
back pain that is aggravated by lifting/twisting. Can have step offs.
212
Spondylolisthesis treatment
50% or neuro deficits: Refer to ortho or neuro.
213
Lumbar spinal stenosis etiology
congentical or degenerative disk disease with hypertrophy of the ligamentum flavum causing narrowing of the neural foramen creating compression.
214
Nerogenic claudication
Seen with lumbar stenosis. progressive low back pain and bilateral leg pain aggravated by standing/walking and relieved by leaning forward.
215
Lumbar stenosis treatment
conservative treatment, epidural steroid injections. Surgery if intractable or neuro deficits.
216
osteomyelitis
infection usually associated with invasive procedues. back pain, malaise, fever, sepsis, wound drainage, elevated EST. Treated with IV antibiotics and surgical drainage.
217
Spinal tumors (secondary)
90%. New onset of low back pain with known malignancy is metastasis until proven otherwise.
218
Femoroacetabular Impingement (FAI) etiology
Progressive bone overgrowth or abnormality that changes the function of the hip. Can lead to labral tears and OA.
219
FAI Pincer
acetabular involvement
220
FAI Cam
Femoral head involvement
221
FAI Presntation
groin and/or lateral hip pain. Sharp throbbing to dull achy. Aggravated with turning/twisting/standing/squatting.
222
FAI test
Impingement Test. FADIT and FABER
223
FADIR test
flexion, adduction then internal rotation
224
FABIR test
figure of four. flexion abduction then external rotation.
225
FAI treatment
decrease aggravation, conservative therapy, surgery if that doesn't work
226
Labral Tear of the hip presentation
dull to sharp groin pain that can radiate to the lateral hip, anterior thigh and/or buttock. catching/clicking.
227
Labral tear of hip Diagnositcs
ROM, strength, FADIR and FABER. MR anthrogram is gold standard.
228
Labral Tear of hip treatment
conservative then refer.
229
Snapping hip syndorme etiology
muscle/tendon sliding over a bony prominence. Can lead to bursitis.
230
Snapping hip external
IT band over greater trochanter.
231
Snapping hip internal
Iliopsoas tendon over the iliopectineal eminence of the femoral head.
232
Snapping hip presentation
snapping/popping sensation, +/- pain, aggravated with activity, pseudosubluxation, difficulty with stairs, rising from seated position.
233
External snapping hip tests
Passive internal/external rotation while on side.
234
Internal snapping hip tests
FABER then extending the hip.
235
Snapping hip treatment
Conservative treatment, steroid injection, PT.
236
Greater Trochanteric Pain syndrome etiology
Most common cause of lateral hip pain. Due to repetitive overload tendinopathy leading to an inflammed bursa.
237
Greater Troch pain Presentation
Lateral hip pain, pinpoint tenderness on greater trochanter, pain with activity.
238
Greater troch pain tests
pain with resisted abduction. Trendelenburg sign.
239
Trendelenburg sign
Can't stabilize the pelvis. The contralateral side dips due to weak pelvic stabilizers.
240
MCL MOI
knee flexed, foot planted with a lateral impact that causes valgus stress and rotation.
241
Triad of O'Donoghue
ACl, MCL, and medial meniscus.
242
ACL MOI
quick position change with valgus stress (pivoting/cutting). or a direct blow that causes hyperextension and valgus stress.
243
ACL function
Most important for knee stability. prevents posterior movement or the tibia as well as rotation.
244
ACL Presentation
"pop" followed by immediate swelling/pain. Feeling of instability. Joint effusion, guarding, usually able to bear weight, laxity.
245
ACL tests
Lachman, anterior drawer test and pivot shift. MRI.
246
ACL Treatment
Conservative. Surgery for younger people and athletes.
247
PCL function
Prevents posterior movement of the tibia and external rotation.
248
PCL MOI
high energy trauma (MVA), low energy trauma (soccer).
249
PCL presentation
gross instability, mild-moderate effusion, generalized knee pain.
250
PCL tests
posterior drawer test and posterior sag sign.
251
Meniscus injury MOI
Usually medial meniscus. Occurs due to excessive rotational force.
252
Meniscus injury presentation
joint line pain, inability to fully extend knee, locking/catching, difficulty with stairs and squatting.
253
meniscus injury tests
mcmurray's, apley's compression/distraction. MRI.
254
Knee sprain Grade I treatment
mild stretch. Conservative treatment.
255
Knee sprain Grade II treatment
partial tear. RICE, brace, crutches, PT, possible surgery.
256
Knee sprain grade III treatment
full tear. surgery, crutches, brace, aggressive PT.
257
Patellofemoral pain syndrome etiology
Malalignment and patellar tracking concerns. Most common knee complaint.
258
Patellofemoral pain presentation
pain behind the patella, worse with stairs, and after sitting for a long time. crepitus, popping, feeling of unstable.
259
patellofemoral pain tests
patellar glide and apprehension test.
260
patellofemoral pain treatment
conservative. PT. brace PRN for comfort.
261
Baker's cyst etiology
accumulation of synovial fluid in the popliteal fossa.
262
Baker's cyst presentation
oftern asymptomatic. pain/swelling with prolonged activity.
263
Baker's cyst treatment
NSAIDS, aspiration/injection, compressive knee brace.
264
Patellar tendonitis etiology
tendon inflammation due to repetitive trauma often from jumping.
265
Patellar tendonitis treatment
Conservative. NO steroid injection.
266
patellar tendonitis presnentation
pinpoint tenderness just inferior to the patella.
267
Iliotibial band syndrome (ITBS) etiology
overuse syndrome usually in runners.
268
ITBS presentation
gradual onset of localized pain and tenderness. reproducible pain with ROM and compression of the ITB. Evaluate for any leg length discrepancies.
269
ITBS treatment
Conservative.
270
Knee bursitis etiology
inflammatory disorder of the bursa usually prepatellar or pes anserine. Caused by trauma or overuse.
271
Knee bursitis presentation
pain/swelling, tenderness. Need to rule out infection.
272
Knee bursitis treatment
NSAIDS, aspiration/injection, padding/brace.
273
Osteochondritis Dissecans (OCD) etiology
lesion of cartilage and underlying bone that results in necrosis and possible displacement.
274
OCD treatment
long-term bracing, activity restrictions, PT.
275
Lateral ankle sprain MOI
inversion with plantar flexion
276
Lateral ankle sprain tests
anterior drawer test.
277
Lateral ligament complex
anterior talofibular, calcaneofibular, and posterior talofibular ligaments.
278
Medial ankle sprain
eversion injury. deltoid ligament complex.
279
Syndesmotic sprain
high ankle sprain. Due to dorsiflexion +/- rotation.
280
Achilles tendinopathy
recent incrase in training regimen, burning pain with activity.
281
Achilles rupture MOI
sudden pivoting or rapid acceleration. violent pop, often pain is absent.
282
Achilles injury test
Thompson test.
283
Achilles injury treatment
refer to ortho. equinos splint with continuous plantar flexion.
284
Plantar fasciitis etiology
inflammation of the fascia due to activity, heel spurs, pes planus/cavus, ankle pronaiton, poor shoe wear.
285
Plantar fasciitis presentation
Pain on plantar aspect of heel. Pain with onset of walking in the morning. uni or bilateral. aggravated with dorsiflexion.
286
Plantar fasciitis treatment
conservative. PT and massage.
287
Osteoporosis treatment
Calcium supplements, estrogen replacement, calcitonin and bisphosphonates.
288
Septic arthritis presentation
increasing pain, redness, warmth, inflammation. surgical emergency.
289
septic arthritis diagnosis
aspiration with culture. CBC, EST, CRP, blood cultures.
290
septic arthritis treatment
IV antibiotics and I/D
291
Unicameral Bone Cyst
common, benign fluid filled cavity in the bone. Surgery if recurrent or pathological fractures.
292
Aneurysmal bone cyst
blood filled cyst in the bone. benign but aggressive. refer to ortho.
293
Non-ossifying fibroma
benign lesion usually found incidentally. MES: metaphysial, eccentric, sclerotic borders. Observe and refer is >50% of diameter.
294
Giant Cell tumor
benign but aggressive. develop as the growth plate closes. localized pain and weakness. refer to ortho for radiation and surgery.
295
Osteoid Osteoma
small, benign tumor. Nidus: center of growing cells surrounded by thick bone. severe night time pain that is resolved with NSAIDS. Refer to ortho.
296
Osteochondroma
exostosis. abnormal growth of bone or cartilage along the bone surface. Most common and bengin tumor. Fixed, non-mobile mass near joints. Some pain with activity. If painful refer to ortho.
297
Osteosarcome/ewings sarcoma
malignant primary bone tumor common in children. Can be aymptomatic until pathological fracture. pain/swelling. Refer to ortho/onc immediately. Fast growing.
298
Chondrosarcoma
Bone tumor composed of cartilage-producing cells. >40 years of age. pain and weakness. refer to ortho.
299
Multiple myeloma
most common primary bone tumor. > 40 years of age, black people. Involves the entire skeleton.
300
Multiple myeloma presentation
fatigue, fever, night sweats, diffuse bone tenderness, pathological fractures.
301
Multiple myeloma diagnosis
UA with bence jones proteins. radiograph that shows punched out appearance.
302
Most common cause of metastatic bone cancer in men
prostate and lung
303
most common cause of metatstatic bone cancer in women
breast.
304
Causes of metastatic bone cancer
prostate, lung, breast, kidney and thyroid cancer.
305
Metastatic bone cancer presentation
asymptomatic until pathological fracture. anemia. osteolytic bone destruction and osteoblastic formation.
